MEDICARE: EMMA GRACE DAW OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	17488	NC
2	225100000X	Physical Therapist	341445	LA

General Provider Information

NPI Number	:	1477284776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA GRACE DAW OTR/L

Provider Business Mailing Address
First Line	:	229 SERENITY CREST ST
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-5304
Country	:	US
Telephone Number	:	571-314-7401
Fax Number	:

Provider Business Practice Location Address
First Line	:	171 N GIBSON RD STE 140
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-6787
Country	:	US
Telephone Number	:	702-360-1137
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2022
Last Update Date	:	09/22/2025

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Directions to “ EMMA GRACE DAW OTR/L” Practice Location

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